Saint Peter's University Hospital / Rutgers Robert Wood Johnson Medical School New Brunswick, NJ
Award: ACG Presidential Poster Award
Archit Garg, MD1, Vishali Moond, MD1, Mehak Bassi, MD1, Sahil Raval, MD1, Aadhithyaraman Santharaman, MD1, Abhishek Chouthai, MD1, Sunny Kumar, MD2, Umesh Bhagat, MD3, Marcella Pimpinelli, MD1, Louisa Recinos-Arenas, MD1, Arkady Broder, MD, FACG1 1Saint Peter's University Hospital / Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 2Wright Center for Graduate Medical Education, Scranton, PA; 3Cleveland Clinic Foundation, Cleveland, OH Introduction: Acute pouchitis can develop in up to 70% of patients with ileal pouch anal anastomosis (IPAA) and progress to chronic pouchitis (CP) in about 15% cases. Biologics and immunomodulators have shown promising results in managing CP. The study aimed to assess the efficacy and safety of tofacitinib compared to vedolizumab and ustekinumab for CP in IBD patients. Methods: We searched multiple databases from inception through November 2024 for articles reporting outcomes of tofacitinib, vedolizumab or ustekinumab in patients with CP. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied by I2 statistics. Results: We analyzed 23 (18 retrospective and 5 prospective) studies. Total subjects included were 525 (51.62% males). The clinical response rate was 47.7% [Cl 33.3-62.6%; I2= 40%] with tofacitinib, 54.9% [Cl 31.5-76.4%; I2= 90%] with vedolizumab and 73.3% [Cl 50.9-87.9%; I2= 78%] with ustekinumab. The endoscopic response rate was 51.7% [Cl 37.4-65.7%; I2=34%] with tofacitinib, 58.5% [Cl 44.5-71.2%; I2 60%] with vedolizumab and 58.5% [Cl 19.3-57.7; I2=71.2%] with ustekinumab. The endoscopic remission rate with tofacitinib, vedolizumab and ustekinumab were 41.2% [Cl 26.6-57.6%; I2= 0%], 40% [Cl 23.9-58.7%; I2=79%] and 36.4% [Cl 19.3-57.7%; I2=0%] respectively. The pooled adverse events were higher with tofacitinib, 30.9% [Cl 17.5-48.5; I2=24%] compared to 17% [Cl 4.9-44.8%; I2=90%] with vedolizumab and 4.6% [Cl 1-17.8%; Cl 58%] with ustekinumab. The discontinuation rate of the drug was highest with tofacitinib 43% [Cl 25-63.1; I2=40%] followed by vedolizumab, 30.3% [Cl 20.4-42.5%; I2=60%] and then ustekinumab 12.5% [CI 6.1-42.5%; I2=0%]. The reason for discontinuation was lack of improvement of symptoms or worsening of pouchitis. Further results are summarized in Tables 1 and 2. Discussion: Based on this meta-analysis, although not statistically significant, ustekinumab showed maximum clinical response followed by vedolizumab and tofacitinib (73.3% vs 54.9% vs 47.7%). Similarly, endoscopic response rates were more with ustekinumab and vedolizumab compared to tofacitinib (58.5% vs 58.5% vs 41.2%). Tofacitinib was associated with more adverse effects and discontinuation rates as compared to ustekinumab and vedolizumab. Our results suggest that ustekinumab might be a better choice for CP when compared to vedolizumab or tofacitinib. Future direct comparison studies are warranted to establish these findings.
Figure: Table 1: Pooled outcomes comparing tofacitinib, vedolizumab and ustekinumab
Figure: Table 2: Comparison of tofacitinib, vedolizumab and ustekinumab in terms of changes in clinical, endoscopic and total PDAI (pouchitis disease activity index) scores
Disclosures: Archit Garg indicated no relevant financial relationships. Vishali Moond indicated no relevant financial relationships. Mehak Bassi indicated no relevant financial relationships. Sahil Raval indicated no relevant financial relationships. Aadhithyaraman Santharaman indicated no relevant financial relationships. Abhishek Chouthai indicated no relevant financial relationships. Sunny Kumar indicated no relevant financial relationships. Umesh Bhagat indicated no relevant financial relationships. Marcella Pimpinelli indicated no relevant financial relationships. Louisa Recinos-Arenas indicated no relevant financial relationships. Arkady Broder indicated no relevant financial relationships.
Archit Garg, MD1, Vishali Moond, MD1, Mehak Bassi, MD1, Sahil Raval, MD1, Aadhithyaraman Santharaman, MD1, Abhishek Chouthai, MD1, Sunny Kumar, MD2, Umesh Bhagat, MD3, Marcella Pimpinelli, MD1, Louisa Recinos-Arenas, MD1, Arkady Broder, MD, FACG1. P1034 - Comparative Outcomes of Tofacitinib, Vedolizumab and Ustekinumab in Chronic Pouchitis: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
